1. Intake Form Information

Background
For over 35 years, HealthPartners has brought workplaces, health charities and the communities of people with lived experience they serve together under one shared purpose – to improve the lives of those affected by illness. Our Health Advisory Network is a platform for those affected by many different illnesses to share their experiences, influencing donors and decision makers to help build a healthier Canada for us all.


Intake Form
This voluntary intake form is for those who would like to become part of HealthPartners’ Health Advisory Network (HAN) and be contacted by HealthPartners. It is designed to better understand your experience with acute and/or chronic disease(s) .

Your responses will only be used to support recruitment and planning for the HAN. All personal information is collected, used, and stored in accordance with applicable privacy laws. Access to this information is strictly limited to authorized HealthPartners personnel and trusted partners as necessary to fulfill HAN operational purposes. Data is securely stored within our systems and retained only as long as required.

For questions or concerns about your information, please contact us directly at network@healthpartners.ca.

This intake form will take approximately 10-15 minutes to complete.
 
20% of survey complete.

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